AB0593 CORRELATIONS BETWEEN PATHOLOGIC SUBSETS AND PET METABOLIC ACTIVITY IN A MONOCENTRIC COHORT OF 46 PATIENTS WITH BIOPSY PROVEN TEMPORAL ARTERITIS. AN OBSERVATIONAL RETROSPECTIVE ANALYSIS

Background

Temporal arteritis is the most common systemic vasculitis in patients aged >50 years, the most serious complications of which is visual loss. The arterial biopsy is the diagnostic gold standard; alongside the classic finding of transmural infiltrate and giant cells, other abnormalities have been described, of which it is not yet known whether they identify specific clinical subsets. PET is not yet used for diagnosis, but it can be suggestive in patients with high clinical suspect; it may be useful for assessing the extention of the disease in already diagnosed patients and for ruling out alternative diagnoses as infections and neoplasms. More recently, PET has been used to assess disease metabolic activity

Objectives

The aim of our study is to evaluate, in patients with histologically confirmed temporal arteritis, correlations between pathological subsets, metabolic activity and different clinical behavior.

Methods

We have recovered the medical records of patients with the diagnosis of temporal arteritis made in our Rheumatology service from January 2007 until now. We selected those satisfying the ACR 1990 criteria and, finally, those with a positive biopsy. We analyzed age at onset of symptoms, diagnostic delay, presence of PMR, fever, constitutional symptoms, headache, temporal artery induration, visual loss; we analyzed CRP, ESR, plasmatic Hb, PLT count, hypocomplementemia, ANA, aCL, ANCA. The referring pathologist, who didn’t know the history of patients, re-examined all the biopsies performed, focusing on: transmural, periadventitial, limited to small vessels or vasa vasorum infiltrate, presence of giant cells, macrophages, eosinophils, neutrophils, lymphocytes, plasmacells, stenosis, thrombosis, fibrinoid necrosis. The nuclear doctor retrieved the PET images by re-assigning each patient the relative PET VAS score. Descriptive analysis was performed: absolute and percentage frequencies were calculated for categorical variables and mean, standard deviation, range and percentiles for quantitative variables. The relationship between variables was tested by the chi-square test and the Mann-Whitney rank test. All analyzes were performed with the STATA software 14.2.

Results

We analyzed 46 patients (F 32, M 14), average age at onset of symptoms of 75.5 yrs and average diagnostic delay of 3.2 months. Headache was reported by 37 patients, fever and asthenia by 26 and 24 respectively, jaw claudication and PMR by 18 and 7. 11 patients had visual loss while 4 and 2 respectively reported amaurosis and diplopia. Temporal artery induration was described in 24 patients. Tests of systemic inflammation were abnormal (mean CRP 85 mg/L, ESR 72.7 mm /1h); the finding of hypocomplementemia (1/26 patients), ANA, aCL and ANCA positivity (2/31, 1/27 and 1/25) was negligible. Histological analysis showed the prevalence of transmural infiltrate (100% of patients), giant cells (87%) and lymphocytes/macrophages (85% both); small vessel vasculitis (59%) and the presence of plasma cells (53%), neutrophils (48%) and eosinophils (22%) were less represented. Periadventitial infiltrate was described in 29% of patients, with negligibility of vasculitis limited to the adventitia and of the vasa vasorum (2 and 0/46). Intimal hyperplasia and necrosis (22 and 14/46) prevailed over calcifications, stenosis and thrombosis (7-5-1/46). PET was available in 14 patients including 6 positive (43%), with a median PET VAS score of 7 (range 6-21); 8/13 patients had not taken steroids prior to PET.

Conclusion

In our retrospective study we observed, in addition to transmural infiltrate and giant cells, the presence of lymphocytes, macrophages and small vessel vasculitis. No correlation was observed between clinical findings, biological and metabolic activity, apart from the increased presence of giant cells in PET positive patients. Visual loss is slightly more common in PET negative patients. This may be due to severity of the cases which needed early steroid treatment.

Disclosure of Interests

Francesco Girelli: None declared, Silvia Asioli: None declared, Riccardo Galassi: None declared, Daniela Tirotta: None declared, Chiara Bellini: None declared, Simone Bernardi Paid instructor for: Paid instructor for Pharmaceuticals in 2013, Lucia Gardelli: None declared, Linda Petrini: None declared, Elisabetta Fabbri: None declared, Paolo Muratori: None declared

[Sentinel lymph nodes in early gastric cancer: preliminary feasibility study]

From January to December 2004, 8 patients with pre-operative diagnosis of early gastric cancer (EGC) and no nodal involvement were submitted to sentinel node biopsy using the dual mapping procedure with endoscopic blue dye and 99mTc radio-colloid injection. All the patients underwent standard radical gastrectomy and D2 lymphadenectomy. The resected nodes were evaluated by routine (hematoxylin-eosin) histopathological examination; the sentinel (blue or hot) nodes in addition were evaluated with immunohistochemistry for cytokeratin. The preliminary results and perspectives for feasibility of sentinel node biopsy and its accuracy in predicting the nodal status in EGC are discussed.

Luminescent chains formed from neutral, triangular gold complexes sandwiching TlI and AgI. Structures of (Ag([Au(mu-C2,N3-bzim)]3)2)BF4.CH2Cl2, (Tl([Au(mu-C2,N3-bzim)]3)2)PF(6).0.5THF (bzim = 1-benzylimidazolate), and (Tl([Au(mu-C(OEt)=NC6H4CH3)]3)2)PF6.THF, with MAu6 (M = Ag+, Tl+) cluster cores

It has been found that several trinuclear complexes of AuI interact with silver and thallium salts to intercalate Ag+ and Tl+ cations, thereby forming chains. The resulting sandwich clusters center the cations between the planar trinuclear moieties producing structures in which six AuI atoms interact with each cation in a distorted trigonal prismatic coordination. The resultant (B3AB3B3AB3)infinity pattern of metal atoms also shows short (approximately 3.0 A) aurophilic interactions between BAB molecular centers. These compounds display a strong visible luminescence, under UV excitation, which is sensitive to temperature and the metal ion interacting with the gold. X-ray crystal structures are reported for Ag([Au(mu-C2,N3-bzim)]3)2BF4CH2Cl2 (P1, Z = 2, a = 14.4505(1) A; b = 15.098(2)A; c = 15.957(1)A; alpha = 106.189(3) degrees; beta = 103.551(5) degrees; gamma = 101.310(5) degrees); Tl([Au(mu-C2,N3-bzim)]3)2PF(6)05C4H8O (P1, Z = 2, a = 15.2093(1)A; b = 15.3931(4)A; c = 16.1599(4)A; alpha = 106.018(1) degrees; beta = 101.585(2) degrees; gamma = 102.068(2) degrees); and Tl([Au(mu-C(OEt)=NC6H4CH3)]3)2PF6.C4H8O (P2(1)/n, Z = 4, a = 16.4136(3)A; b = 27.6277(4)A; c = 16.7182(1)A; beta = 105.644(1) degrees). Each compound shows that the intercalated cation, Ag+ or Tl+, coordinates to a distorted trigonal prism of six AuI atoms. The counteranions reside well apart from the cations between the cluster chains.

Diagnostic role of gallium scanning in the management of lymphoma with mediastinal involvement

BACKGROUND AND OBJECTIVE

Therapy of both Hodgkin's disease (HD) and aggressive non-Hodgkin's lymphoma (NHL) with mediastinal presentation at the time of diagnosis is frequently followed by radiological detection of residual masses. Computed tomography (CT) scanning is generally unable to detect the differences between tumor tissue and fibrosis. Gallium-67-citrate single photon emission ((67)GaSPECT) can potentially differentiate residual active tumor tissue from fibrosis.

DESIGN AND METHODS

Seventy-five patients with HD or aggressive NHL presenting mediastinal involvement (64% with a bulky mass) were studied with CT and (67)GaSPECT at the end of combined modality therapy (chemo- and radiation therapy).

RESULTS

After treatment, 3/3 (100%) patients with positive (67)GaSPECT and negative CT scan relapsed while only 1/18 (6%) patients with both negative (67)GaSPECT and CT scan did so. At the same time, 54 patients had a positive restaging CT scan (abnormal mass < 10% of size of initial mass). Of these patients, 13 had a positive (67)GaSPECT, 10 of whom (77%) relapsed; 41 had a negative (67)GaSPECT of whom 5 (12%) relapsed. The 4-year actuarial relapse-free survival rate was 90% for those with negative scans compared with 23% for gallium-positive patients (p < 0.000000).

INTERPRETATION AND CONCLUSIONS

In lymphoma patients with mediastinal involvement, (67)GaSPECT should be considered, at least in patients who are CT positive, the imaging technique of choice for monitoring and differentiating the nature of any residual masses.

Hemiarthroplasty of the shoulder. Clinical experience in 18 cases treated by the Neer monoblock prosthesis

The authors report the results of 18 hemiarthroplasties of the shoulder performed between 1990 and 1994 using the Neer II monoblock prosthesis, emphasizing the technical and surgical problems encountered. The patients treated numbered 13 for traumatic pathology (acute fractures: 7; sequelae of fracture of the proximal epiphysis of the humerus: 6), and 5 for degenerative lesions (arthrosis: 3; rheumatoid arthritis: 2). An evaluation of the results was based on the Constant method and isokinetic testing. Results based on follow-up obtained after 2 to 6 years were satisfactory in 83% of the cases.

Isokinetic testing to evaluate patients submitted to surgery for the treatment of surgical lesion of the rotator cuff

A total of 100 cases surgically treated for rupture of the extra-rotator cuff were evaluated by isokinetic testing. Results were evaluated after a period of time ranging from 1 to 4 years, based on the Constant system, defining the type of lesion of the cuff based on the Snyder classification system, and measuring strength postsurgery using isokinetic testing after 3 and 6 months, and 1 year. Isokinetic testing made it possible to accurately evaluate which patients are capable of obtaining better recovery, and how much time is required for physiotherapy for postoperative rehabilitation, also allowing for correction on an individual basis of any muscular imbalance.

Evaluation of lung clearance of inhaled pertechnegas

Pertechnegas is a new ventilation agent produced by modifying the atmosphere of combustion of Technegas. Due to its rapid disappearance from the lungs, Pertechnegas has been suggested as useful in measuring pulmonary epithelial permeability. This study aimed to assess the reliability of ventilation scans with Pertechnegas to evaluate alveolar-capillary permeability. Six non-smokers with no evidence of pulmonary disease were investigated. Scintigraphic data were used to evaluate the site of Pertechnegas deposition (by assessing the Penetration Index [PI] of the gas), its clearance rate (by calculating the time to half-clearance [T1/2]) and its lung distribution (by means of a pixel-by-pixel analysis. PI measurements produced a mean value of 88.8 +/- 13.3% (range 69-117%). Time activity curves showed a fast clearance in all cases (mean T1/2 = 10.7 +/- 2.1 min, range 8.1-14.3 min). Comparison of statistical indices of uniform deposition (skewness and kurtosis) indicated satisfactory homogeneity of Pertechnegas distribution throughout the lungs. These data show that after inhalation Pertechnegas has a peripheral deposition and a homogeneous distribution in the lungs and is rapidly cleared through the alveolar-capillary barrier. In conclusion Pertechnegas can be recommended as a potential radiopharmaceutical for studying the pulmonary epithelial barrier.

Increased susceptibility to lipid oxidation of low-density lipoproteins and erythrocyte membranes from diabetic patients

The aim of the present study was to determine if low-density lipoproteins (LDLs) and red blood cell (RBC) membranes from diabetic patients present an increased susceptibility to lipoperoxidation, which might be related to the increased incidence of atherosclerosis in diabetes. LDLs and RBC membranes were isolated from 11 insulin-dependent (IDDM) and 18 non-insulin-dependent diabetic (NIDDM) patients and exposed to a peroxidative stress by incubation with phenylhydrazine. The susceptibility to peroxidation was determined by measuring the production of thiobarbituric acid-reactive substances (TBARS) after the incubation. The following parameters were also evaluated: plasma glucose, triglycerides (TG), phospholipids (PL), total and high-density lipoprotein (HDL) cholesterol, apolipoprotein (apo) A-I, apo B, hemoglobin A1c (HbA1c), LDL PL and cholesterol, LDL fatty acid composition, and RBC membrane PL and cholesterol. Although they were apparently normolipidemic, diabetic patients showed an increased susceptibility to peroxidation in LDLs and erythrocyte membranes as compared with control subjects. The amount of arachidonic acid in LDLs and the PL concentration of RBC membranes from diabetic patients were significantly higher than in normal subjects. The increased lipoperoxidability of both RBC membranes and LDLs might play a central role in the pathogenesis of the vascular complications of diabetes mellitus.

Modified fluidity and lipid composition in lipoproteins and platelet membranes from diabetic patients

The interaction between lipoproteins and the platelet membrane has been proved to cause a modification in cellular functions. We studied 12 men with insulin-dependent diabetes mellitus (IDDM), 14 men with noninsulin-dependent diabetes mellitus (NIDDM), and 26 age-matched healthy men on the same diet. We determined fluidity by measuring the fluorescence polarization (P) of the probe 1,6-diphenyl-1,3,5-hexatriene (DPH) both in platelet membranes and in lipoproteins isolated by ultracentrifugation in NaBr density gradient. The lipid composition of lipoproteins and of platelet membranes was determined by enzymatic methods. The fluidity of platelet membranes was significantly increased both in patients affected by NIDDM and in subjects with IDDM compared with normal subjects. Low-density lipoproteins (LDL) showed an increased fluidity only in NIDDM patients. A percent increase in the triglyceride content was observed in all lipoprotein fractions in diabetic subjects. Increased phospholipid content was found in the platelet membranes from IDDM and NIDDM patients. The change in LDL fluidity observed in NIDDM patients might determine altered interactions between the lipoprotein and cellular receptors. The role of lipoproteins in the modulation of the platelet membrane properties in diabetes mellitus deserves further studies.

Reduced Na(+)-K(+)-ATPase activity and plasma lysophosphatidylcholine concentrations in diabetic patients

A fraction from normal human plasma inhibiting Na(+)-K(+)-ATPase has been recently identified as lysophosphatidylcholine (LPC). The aim of this study was to investigate the existence of a relationship between the activity of the cellular membrane Na(+)-K(+)-ATPase and plasma LPC in human diabetes. We studied 10 patients with insulin-dependent-diabetes mellitus (IDDM), 14 patients with non-insulin-dependent diabetes mellitus (NIDDM), and 10 sex- and age-matched control subjects. Plasma LPC concentrations were increased in both IDDM and NIDDM patients compared with control subjects. Na(+)-K(+)-ATPase activity was reduced in both groups of patients in erythrocyte and platelet membranes. There was a significant correlation between the concentrations of plasma LPC and Na(+)-K(+)-ATPase activity in both erythrocyte and platelet membranes (P < 0.01). To investigate the effect of LPC on the enzyme, Na(+)-K(+)-ATPase activity was determined in erythrocyte membranes obtained from six healthy subjects after in vitro incubation with increasing concentrations of LPC (1-10 microM). Enzymatic activity was significantly reduced by in vitro LPC at a concentration of 2.5 microM, with a further decrease at 5 microM. These data suggest that the decrease in Na(+)-K(+)-ATPase activity in diabetes might be due to increased LPC concentrations.

Pregnancy induced hypertension: a role for peroxidation in microvillus plasma membranes

It has been recently hypothesized that in PIH a placental oxidant-antioxidant imbalance might cause the release of lipoperoxidation products into the circulation, with subsequent damage of endothelial cell membranes. In this hypothesis the endothelial cell and further increase in circulating lipoperoxide levels, which are by themselves able to induce smooth muscle constriction and increased pressor responsiveness to angiotensin II. In order to investigate this issue, we studied the basal content of lipid peroxides in terms of malondialdehyde (MDA) in the syncytiotrophoblast plasma membranes (SPM) from PIH women. Moreover, we investigated the susceptibility to peroxidation of SPM using an in vitro oxidative stress as a tool to verify the predisposition to the in vivo development of peroxidation products. The fatty acid composition of the membranes was also analyzed. Microvillus membrane lipoperoxide concentrations were significantly increased in PIH women (62.8 +/- 7.6 ng MDA/mg prot) compared with healthy pregnant subjects (37.6 +/- 4.8 ng MDA/mg prot; p < 0.01). The formation of TBARS under the action of phenylhydrazine was significantly greater in PIH women (90.3 +/- 7.4 mmol MDA/mol cholesterol) than in normal pregnant subjects (68.6 +/- 6.4 mmol MDA/mol cholesterol; p < 0.01). In PIH microvillus membrane we also observed a significant increase of the content of polyunsaturated arachidonic acid. The increased susceptibility to oxidative stress of SPMs from PIH women might be due either to reduced antioxidant systems or to an abnormality of the lipid composition of the membrane.(ABSTRACT TRUNCATED AT 250 WORDS)